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This section focuses on studies in which multiple therapies are compared in regard to safety and efficacy for the treatment of the same disease type. These drugs are already used in clinical practice.

Dupilumab treatment was observed to be associated with reduced severe asthma exacerbation rates as well as improved lung function when compared with other biologic treatment options, according to recent data.

“Currently, five biologic treatment options are available for use in patients with uncontrolled persistent asthma,” explained Eric D Bateman, MB ChB, MD, FRCP, DCH, division of pulmonology, department of medicine, University of Cape Town, Cape Town, South Africa, and colleagues in a recent study. “[This includes] three interleukin (IL)-5 antagonists, which either bind to the anti-IL-5 ligand (mepolizumab, reslizumab) or to the IL-5 receptor (benralizumab); one anti-immunoglobulin E (anti-IgE) therapy (omalizumab); and one anti-IL-4/IL-13 therapy (dupilumab).”

Because little comparative data for these biologics exist, Dr Bateman and colleagues conducted an indirect treatment comparison of dupilumab vs each of the anti-IL-5 and anti-IgE therapies. Primary measures included annualized severe asthma exacerbation rates and change in prebronchodilator forced expiratory volume in FEV1.

Comparative study data between January 1, 1980 and March 25, 2019 was sourced from Embase, MEDLINE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases. To be eligible, articles included randomized control trials with patients aged ≥ 12 years with persistent/uncontrolled asthma using at least medium-to-high dose inhaled corticosteroid plus long-acting β2-agonist with add-on biologic therapy. The researchers conducted Bucher indirect treatment comparisons to compare subgroups of dupilumab patients with the anti-IL-5s and anti-IgE trial populations. The final cohort included 14 randomized controlled trials.

“The matched dupilumab subgroups were associated with greater reductions in annualized severe exacerbation rates compared with benralizumab, mepolizumab, reslizumab, and omalizumab (54%, 28%, 38%, and 26% greater reduction, respectively),” found the researchers.

The researchers also observed a greater improvement in FEV1 for dupilumab at week 12 and/or week 24/52 than for the other biologics (0.06–0.14 L).

In the absence of any head-to-head trials, our analysis may be useful to clinicians and decision-makers considering these treatments for patients with uncontrolled persistent asthma,” concluded researchers.

—Edan Stanley

Bateman E, Khan A, Xu Y et al. Pairwise indirect treatment comparison of dupilumab versus other biologics in patients with uncontrolled persistent asthma. Respir Med. 2020:105991. doi:10.1016/j.rmed.2020.105991

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